title: The clinical utility of the combination of T stage and venous invasion to predict survival in patients undergoing surgery for colorectal cancer.
abstract: OBJECTIVE
  To examine the clinical utility of improved detection of venous invasion (VI) in patients undergoing potentially curative resection of colorectal cancer.
  
  
  BACKGROUND
  VI is a feature of colorectal cancer (CRC) progression. Elastica staining can be used to improve detection of VI and correspondingly its prediction of patient survival.
  
  
  METHODS
  A single-center, observational study of pathology variables, including detection of VI by staining for elastica, using 631 stage I to III CRC specimens, collected from 1997 to 2009 (176 analyzed retrospectively and 455 analyzed prospectively), was performed.
  
  
  RESULTS
  VI was detected in 56% of patients with CRC. Over a median follow-up period of 73 months, 238 patients died (134 from cancer). On multivariate analysis, VI by elastica staining was associated with a shorter survival duration, independent of other pathology features, in all cases [hazard ratio (HR) = 3.94, 95% confidence interval (CI): 2.33-6.65, P < 0.001] and in node-negative cases (HR = 3.55, 95% CI: 1.81-6.97; P < 0.001). In the absence of elastica-detected VI, with the exception of T stage, no other pathology features were associated with survival time. Therefore, the combination of T stage and VI (TVI) on survival was examined. Five-year cancer mortality could be stratified between 100% and 54% for patients with node-negative tumors and between 100% and 33% for patients with node-positive tumors. In all cases, the TVI had similar predictive value as that of T stage and node status (TNM). In node-negative disease, TVI had superior predictive value.
  
  
  CONCLUSIONS
  The results of the present study have prompted the development of a novel tumor staging system based on TVI. The TVI has clinical utility, especially in node-negative disease, in predicting outcome following curative resection for CRC.
authors.affiliation: *University Department of Surgery, Glasgow Royal Infirmary †University Department of Pathology, Southern General Hospital, Glasgow, United Kingdom.
authors.forename: Campbell S D
authors.initials: CS
authors.lastname: Roxburgh
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.forename: Colin H
authors.initials: CH
authors.lastname: Richards
authors.forename: Manal
authors.initials: M
authors.lastname: Atwan
authors.forename: John H
authors.initials: JH
authors.lastname: Anderson
authors.forename: Tim
authors.initials: T
authors.lastname: Harvey
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Alan K
authors.initials: AK
authors.lastname: Foulis
mesh_terms: D000368:Aged; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D019043:Vascular Neoplasms / Q000473:pathology* / Q000601:surgery; D014680:Veins